nurs 322 midterm

population aggregate

a collection of people who share one or more personal or environmental characteristics; loosely associated with one another

• ex: living in a particular area, all adults in Broome County with diabetes

community

a collection of people who interact with one another and whose common interest form a basis for a sense of unity of belonging; supporting one another

• ex: a group that meets at a diabetes center weekly

public health core functions

• assessment

• policy development

• assurance

assessment

• systematic data collection on population

• monitor the population’s health status to identify existing or potential health problems

policy development

• inform, educate, empower people regarding health issues

• develop and support local, state, national and international legislation that supports/promotes health and well-being

• use a scientific knowledge base to make policy decisions

• mobilize partnerships

assurance

• make sure that essential community oriented health services are available

• enforce laws and regulations that protect health and ensure safety

• link health services with people

components of community as partner model

• core demographics

• physical environment

• education

• safety and transportation

• politics and government

• health and social services

• communication

• economics

• recreation

core demographics

what the people look like; age, race, religion, ethnicity

• are there churches, festivals, ethnic groceries?

physical environment

• are houses in good shape?

• are there lots of open spaces? national boundaries?

• air/water quality?

(can be observed through windshield)

education

are there schools or libraries in the area? are there a lot of children out?

safety and transportation

types of cars? are there trains/buses? what are the conditions of the roads? are there sidewalks? police/fire department present?

politics and government

• political signs

• local representative offices

• court houses

• jails/prisons

communication

• TV stations

• cell towers

• radio stations

• billboards

• cable lines

• news papers

economics

• condition of housing, shopping centers, restaurants

• big corporations or small businesses

• major employers

• general condition of area

recreation

• gyms

• facilities

• movie theaters

• activity centers

core components of community as partner model

• history of area

• demographics

• values and beliefs

community as partner model process

assessment → analysis → community nursing diagnosis → plan → intervention → evaluation

primary prevention

TO PREVENT disease from OCCURRING

• done when individuals are healthy

• aka the interventions that promote health and prevent disease

• aimed at individuals who are susceptible but have no discernible disease

ex: education, immunizations, lifestyle changes, helmets

secondary prevention

TO DETECT disease in its EARLY STAGES, before clinical signs appear

• medicine to reverse or reduce severity of disease or provide cure

ex: testing and screening, blood pressure testings, administering immunoglobins

tertiary prevention

TO IMPROVE course of disease, REDUCE disability, REHABILITATE

• aimed at people with clinically apparent disease

• exception is individuals will not return to pre-illness function

ex: therapy, palliative care, support groups

Erikson’s psychosocial development theory

teaching process relevant to infancy through adolescence

1. trust vs. mistrust

2. autonomy vs. shame

3. initiative vs. guilt

4. industry vs. inferiority

5. identity vs. role confusion

6. intimacy vs. isolation

7. generativity vs. stagnation

8. ego integrity vs. despair

trust vs. mistrust (0-1.5)

• if care infant receives is consistent, predictable, and reliable → sense of trust develops → transferable to other relationships = sense of security when feeling threatened

• sense of hope develops from successful completion

autonomy vs. shame (1.5-3)

skills and abilities emerge that illustrate the child’s growing sense of independence and autonomy

• if encouraged/supported → become more confident and secure in ability to survive the world

• if criticized, overly controlled, not given opportunity to assert

  themselves → feel inadequate, become overly dependent upon others, lack self-esteem, and feel a sense of shame or doubt in their abilities

initiative vs. guilt (3-5)

• child regularly interacts with other children.

• play is pivotal

  • plan activities, make up games, and initiate activities with others.

• children develop a sense of initiative, feel secure in their ability to lead others and make decisions

• if independence is criticized/controlled → develop a sense of guilt

industry vs. inferiority (5-12)

• success leads to a sense of competence

• expanding relationships outside the nuclear family

• peer groups become important

  ---

• important event is school → learning to cope with academic and social challenges

• gaining awareness of their uniqueness

identity vs. role confusion (12-18)

• learn roles that will be adopted as an adult

• self-identity develops

• body image extremely importatnt

Piaget’s cognitive development theory

1. sensorimotor

2. preoperational

3. concrete operational

4. formal operational

sensorimotor stage (birth-2)

• intelligence demonstrated through motor activity

• knowing the world is based on physical experience

• object permanence, memory, and causality begin to develop around 7 months.

• may experience separation anxiety

preoperational stage (2-7)

• children think in images, symbols

• symbolic play, egocentrism, animism, artificialism, transductive reasoning

symbolic play

imaginary friends or social play with roles assigned

egocentrism

unaware that other viewpoints exist

• ex: “I like Sesame Street so Daddy must like Sesame Street too”

animism

inanimate objects are capable of actions and have lifelike qualities

• "stars twinkle in the sky because they are happy”

artificialism

the belief that environmental characteristics are attributed to human actions

transductive reasoning

does not understand cause and effect

• reasons from specific to specific, drawing a relationship between separate events that are unrelated

• ex: if child wishes someone harm and then something bad happens, the child believes they caused the event

concrete operational stage (7-11)

• ability to understand conservation

• intelligence is demonstrated through logical and systematic manipulation of symbols related to concrete objects

• thinking is less egocentric and operational

formal operational stage (11-adulthood)

• intelligence is demonstrated through logical use of symbols related to abstract concepts

• thought process may be egocentric in early adolescence due to increased independent thinking

• only 35% of high school graduates

Kohlberg’s moral development theory

• level 1: pre-conventional (up to age 9)

  • obedience and punishment orientation

  • individualism and exchange

• level 2: conventional (adolescents/adults)

  • good interpersonal

  • maintaining social ordering

• level 3: postconventional (only 10% of adults)

  • social contract and individual rights

  • universal principles

stage 1: obedience and punishment orientation

the child/individual is good in order to avoid being punished

• if person is punished, they must have done wrong

stage 2: individualism and exchange

• children recognize that there’s not just one right view that is handed down by the authorities

• different individuals have different viewpoints

stage 3: good interpersonal relationships

• individual is good in order to be seen as being a good person by others

• answers relate to approval of others

stage 4: maintaining social order

• individual becomes aware of the wider rules of society

• judgements concern obeying the rules in order to uphold the law and to avoid guilt

stage 5: social contract and individual rights

• individual becomes aware that while rules/laws might exist for the good of the greatest number, there are times when they will work against the interest of particular individuals

• interests are not always clear cut

stage 6: universal principles

• people at this stage have developed their own set of moral guidelines which may or may not fit the law

• principles apply to everyone

audiometry tests

• frequency: 1000, 2000, 4000 hz

• decibels: 20

• 2 correct responses → move onto next frequency

• less than 2 correct out of 4 presentations → mark as refer

Snellen test

vision test for children, stand 20 feet away from chart → read each line from top to bottom

• 2 errors allowed on any line

behaviorist learning theory

• stimulus response model of learning

  • behavior either rewarded or punished

  • behavior is externally motivated

• changing the reward or punishment after the learner’s response can also modify the learner

• learner is PASSIVE

• altering the stimulus can modify the learner’s attitudes and responses

cognitive learning theory

• emphasizes changing the individual’s cognition

  • perceptions, thoughts, memory, and ways of processing and structuring information

• individual interprets new information based on what is already known and then reorganizes the information into new insights and understanding

• learner is ACTIVELY engaged in the process

• reward is not necessary for learning

  • learner’s goals and expectations for learning create a dissatisfaction which motivates learner to act

• factors that affect learning -- past experiences, perceptions, ways of incorporating and thinking about information, expectations and social influences

social learning theory

• perspective on personal characteristics of the learner, behavior patterns, & environment

• focuses on the impact of social factors, and the context where learning occurs

• learner is central: need to identify what the learner is perceiving and how they are interpreting and responding to social situations

• role modeling is the social process from which the learner learns

humanistic learning theory

• holistic approach

• each individual is unique and has desire to grow in a positive way

• emphasizes emotions and learner’s creativity

• self-concept and self-esteem are necessary considerations

• learners, not educators, choose what needs to be learned

  • self responsibility is stressed

domains of learning

ways people learn

cognitive domain

knowledge — storing and recording new knowledge or information (ex: describe, recall)

psychomotor domain

integration of mental and muscular activity (ex: demonstrate, role play)

affective domain

changes in attitudes, values, and feelings (ex: express, respect)

goals

global statement for final outcome of plan or intervention

objectives

what you want the learner to do or know (achieved after one session)

• specifies what learner is expected to be able to do

• includes condition/performance/criterion

SMART

• specific

• measurable

• attainable

• relevant/realistic

• time based

ecological model

looks at individual, social, physical environmental factors that influence a person’s behavior

• assumption:

  • changes in social environment will change the individual

  • supporting the individual is essential for environmental change

• eliminates victim blaming

• change in one level changes the whole picture

intrapersonal (ecological model)

changing the individual rather than the social environment

• attitude, knowledge, skills, intentions, behavior, self-efficacy

interpersonal (ecological model)

changing the nature of the existing social relationship (family, social groups)

• goal is to change norms of group, increase accessibility to positive groups, create alternative networks

institutional/organizational (ecological model)

• social institutions that can influence individual

• school, worksite, and religious organizations

• changing the “corporate culture” -- include health related norms & values as institutions mission

• intervention at this level has access to large # of people, social support for behavioral change

community (ecological model)

• relationship between organizations within defined boundaries

• community power structure, health problems and allocation of resources

• goal : increase coordination between organizations

• coalition building (alliance)

public policy (ecological model)

laws/policies are the most effective way to educate

social determinants of health

• economic stability

• education

• health/healthcare

• neighborhood

• social/community context

economic stability (SDOH)

poverty (% of kids receiving free/reduced school lunch), jobs, food security, housing stability

education (SDOH)

high school graduation, enrollment in higher education, language and literacy, early childhood education and development

health/health care (SDOH)

access to healthcare, access to primary care, health literacy

neighborhood (SDOH)

access to quality food, quality of housing, crime/violence, environment conditions (water, air, soil)

social/community context (SDOH)

social cohesion, civic participation, discrimination, incarceration

Healthy People 1990

• decrease mortality: infants-adults

• increase independence among older adults

Healthy People 2000

• increase span of healthy life

• reduce health disparities

• achieve access to preventive services for all

Healthy People 2010

• increase quality and years of healthy life

• eliminate health disparities

Healthy People 2020

• attain high-quality, longer lives free of preventable diseases

• achieve health equity and eliminate disparities

• create social and physical environments that promote good health

• promote quality of life, healthy development, healthy behaviors across life stages

Healthy People 2030

• attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death.

• eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.

• create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.

• promote healthy development, healthy behaviors, and well-being across all life stages.

• engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all.

UN SDG initiative

started in 2015 → 17 sustainable goals

• not every country participates in the UN

• not every nation has the infrastructure to collect data

• data is necessary to monitor progress

sustainable development goals

• end all forms of discrimination against females everywhere

• eliminate all forms of violence against females in public/private including sex traffic/exploitation

• eliminate harmful practice; forced marriage, female genital mutilation

• recognize/value unpaid care or domestic work through public services, shared responsibility at home

• ensure women’s participation & equal opportunity for leadership

• ensure universal access to sexual / reproductive health and health rights

• undertake reforms for women’s equal rights to economic sources, ownership of land

• enhance use of technology to empower women

• adopt / strengthen policies that can enforce for promotion of gender equality & empower them

unintentional injuries

accidental

• ex: not wearing helmet, drinking and driving, drug overdose

intentional injuries

on purpose

• ex: carry weapon (even for self defense), elder maltreatment

intimacy vs. isolation (19-39)

• important life events are spousal and beginning family relationships

• young adults need to form intimate, loving relationships with other people

• success = strong relationships

• failure = loneliness and isolation

teaching methods/strategies for young adulthood

• use problem-centered focus

• encourage active participation

• organize materials

• recognize social roles

• apply new knowledge through role playing and hands-on practice

generativity vs. stagnation (40-64)

• important life events are work and parenting tasks

• adults need to create or nurture things that will outlast them, often by creating a positive change that benefits other people

• success = feelings of usefulness and accomplishment

• failure = shallow involvement in the world

teaching methods/strategies for middle adulthood

• focus on maintaining independence and re-establishing normal life patterns

• assess potential sources of stress due to midlife crisis issues

• provide information to coincide with life concerns and problems

ego integrity vs. despair (65+)

• important life event is reflection on life

• older adults need to look back on life and feel a sense of fulfillment

• success = feelings of wisdom

• failure = regret, bitterness, and despair

teaching methods/strategies for older adulthood

• build on past life experiences

• allow time for processing with verbal exchange and coaching

• speak slowly and distinctly

• use analogies

• face client when speaking

• use visual aids

• use large letters

• provide sufficient light

• use white backgrounds and black print

women’s health concerns

• eating disorders

• reproductive health

• gestational diabetes

• menopause

• breast cancer

• osteoporosis

men’s health concern

• prostate cancer

• testicular cancer

• erectile dysfunction

health belief model

unless a person sees some value in making a change, there will be no reason to consider making a change

perceived susceptibility

how much the person believes they’re at risk

perceived severity

how serious they think the consequences of getting the disease is

perceived barriers

perceived problems to overcome in changing the behavior or health outcome

perceived benefits

perception that there are benefits to be gained from changing the behavior

likelihood of action

benefits of preventive actions minus perceived barriers

self-efficacy

person’s expectations relative to action; belief they can do the behavior/action

• involves strategies such as modeling, demonstration, verbal reinforcement

precontemplation

no intention of changing; unaware they have a problem

contemplation

aware of problem and seriously thinking of resolving it but no commitment made

preparation

stage of decision making, committed to take action for change within 30 days (small changes)

action

making the actual change; modified the target behavior to an acceptable criterion

maintenance

work to stabilize the change and avoid relapse

precontemplation → contemplation

• consciousness raising

• dramatic relief

• environmental re-evaluation

consciousness raising

find and learn new facts, ideas and tips that support healthy behavior change

dramatic relief

experience negative emotions associated with unhealthy behavioral risks